APPLICATION TO ACCESS EMERGENCY WITHDRAWAL OF …

APPLICATION TO ACCESS

EMERGENCY WITHDRAWAL OF PENSION FUNDS

PLEASE SUBMIT TO YOUR PENSION PLAN ADMINISTRATOR

BAF Pension Plan

NAME OF PENSION PLAN:_______________________________________________________________________

MEMBER NAME:____________________________________________________________________________

DATE OF BIRTH:

MEMBER NO. ________________________________

day/month/year

POSTAL ADDRESS:

CONTACT NUMBER(S):

__

EMAIL ADDRESS:

WITHDRAWAL

I fully understand that any withdrawal of benefits from my plan will directly affect my future retirement

benefit. I fully understand that due to the current global economy and market conditions this withdrawal

should ONLY be considered in an emergency situation.

I wish to apply for the requested amount of KYD$_______ or USD$_______ OR by checking the following box , I wish to

receive 100% of the pension funds available to me under the Emergency Withdrawal provisions.

Please note that if the amount requested is in excess of the maximum available under the Emergency Withdrawal provisions,

then the maximum amount under the National Pensions (Amendment) Law, 2020 will be paid.

REQUIRED DOCUMENTATION

In addition to this application, I have attached the following supporting documentation:

Original Government issued photo ID with signature provided to pension plan administrator in person OR Copy of

Government issued photo ID with signature that has been notarised by a Notary Public or Certified by a JP.

If I am no longer in the Cayman Islands, I have also attached a copy of my ticket showing my departure date of 1

February 2020 or later.

DECLARATIONS

I hereby declare the following information to be true:

______________

I understand that under the Emergency Withdrawal provisions, I am entitled to a one-time

withdrawal and hereby apply for that withdrawal.

Initials

Initials

Initials

I understand that I cannot withdraw if I am a public servant and the pension contributions

held in my account were contributed by a public entity.

I am presently in the Cayman Islands or have departed since the 1st February, 2020 as evidenced

by a copy of my final ticket (circle which is applicable)

Only completed applications will be accepted by the pension plan administrators. All incomplete applications will be

rejected until the required documents are provided.

PAYMENT DETAILS

I would like payment in the following form:

Cheque made payable in KYD

or USD

¨C (If you don¡¯t have a bank account for

the payment to be deposited, please contact your pension plan administrator)

Wire transfer (Please complete section below for local transfers. For non-domestic payments,

please contact your pension plan administrator for their wire transfer template)

DOMESTIC PAYMENT OPTION ONLY (for non-domestic payments, please contact your

pension plan administrator for their wire transfer template) Funds will ONLY be

transferred to a bank account in the member¡¯s name.

___________

A person who knowingly or willfully provides false or misleading information in this application

commits an offence and is liable on summary conviction to a fine of ten thousand dollars or to

imprisonment for a term of one year, or to both.

The information provided in this document, which is signed by me, is made to the best of my

knowledge and belief. I make it knowing that if it is tendered, I shall be liable for prosecution, if I

have willfully stated in it anything that I know to be false or do not believe to be true.

Member Signature ______________________________________________________________

(Signature as it appears in Government ID)

Date: ____________________________________________________________________________

TIMELINES

Following the submission of the application, please note the following timelines:

?

The administrator shall:

o within 7 days of receiving the application under this Part, notify the applicant of

the administrator¡¯s receipt of the application;

o within 14 days of notifying the applicant of the administrator¡¯s receipt of the

application, notify the applicant of the administrator¡¯s decision to approve or

refuse the application.

o within 45 days of receipt of the application, issue the amount in the form of a

cheque or by direct deposit payable to the financial institution instructed by the

applicant

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